Nm 602 Module 4 Study Guide/worksheet 2

Front 1

Physiologic Basis for Symptoms Encountered During Pregnancy
Nausea & vomiting
p. 427-428

Back 1

•Exact cause unknown
•Nausea and vomiting in pregnancy (NVP) generally begins between 4-6 weeks, peaks at 8-12 weeks, usually revolves by 10-12 weeks
•NVP incidence and severity is often linked to dietary cravings and aversions

Hint 1

•Theories regarding high levels of estrogen, hCG, and possibly thyroxine

Front 2

Physiologic Basis for Symptoms Encountered During Pregnancy
Fatigue
p. 70 – 1st trimester
p. 72 – 3rd trimester

Back 2

Increased metabolism of pregnancy – causes the pregnant woman to tire sooner and more easily.

Weight of enlarged uterus and fetus.

Hint 2

•Progesterone
•Increased T4

Front 3

Physiologic Basis for Symptoms Encountered During Pregnancy
Breast tenderness

p. 70, p.159-160

Back 3

Breasts are enlarging and preparing for lactation.

Hint 3

•Progesterone
•Estrogen
•Human placental lactogen (hPL)
•Prolactin

Front 4

Physiologic Basis for Symptoms Encountered During Pregnancy
Flatulence

Back 4

Progesterone causes slowed peristalsis – food in the intestine longer so bacteria have more time to produce gas.

Hint 4

•Progesterone

Front 5

Physiologic Basis for Symptoms Encountered During Pregnancy
Round ligament pain

Back 5

Most likely on the right because the uterus is dextrorotated. Growing uterus causes the round ligament to stretch and it is easier to spasm.

Hint 5

•None
•Relaxin and estrogen help the round ligament to stretch.

Front 6

Physiologic Basis for Symptoms Encountered During Pregnancy
Headaches

p. 551

Note: Need to rule out preeclampsia as a cause

Back 6

•Estrogen causes hypertrophy of the mucous membranes- congestion can cause headaches, serous otitis, swollen gums, epulis, nasal congestion, etc.
•Tension headaches during pregnancy may be due to ocular changes, nasal congestion, emotional tension, muscle spasm, fatigue, altered cerebral fluid dynamics, or mild respiratory acidosis

Hint 6

•Estrogens interact with the trigeminovascular system to alter cerebral blood flow and neurochemical release

Front 7

Physiologic Basis for Symptoms Encountered During Pregnancy
Gingivitis, epulis

Back 7

Epulis is a small swelling of the gums (AKA angiogranuloma) between the teeth that is easy to bleed. It is seen in advanced gingivitis. Gingivitis in pregnancy is related to alterations in the inflammatory process in pregnancy and to the estrogen effect. Estrogen increases blood flood and causes swelling of mucous membranes. Gums are vascularized, hyperplastic, and edematous, which makes the woman more susceptible to gingivitis.

Hint 7

•Estrogen

Front 8

Physiologic Basis for Symptoms Encountered During Pregnancy
Palpitations

p. 267 and 276

Back 8

•Increased plasma volume
•Increased cardiac output

Hint 8

•Maternal hemodynamic changes mediated by  estrogen, progesterone, prostaglandins (esp. PGE1 and PGE2)

Front 9

Physiologic Basis for Symptoms Encountered During Pregnancy
Chloasma and linea negra
p. 517-518

Back 9

•Increased distribution of melanin in areas of the skin.
•May also see increased pigmentation of freckles, moles, scars, areolae, axillae, genital area, & linea alba becomes linea negra.

Hint 9

•Estrogen and progesterone stimulate the increase in melanocyte stimulating hormone
•Fade in postpartum but may remain in darker skinned women.
•Sun exposure makes it worse.

Front 10

Physiologic Basis for Symptoms Encountered During Pregnancy
Dyspnea

Back 10

•Increased respirations
•Perceived more rapid breathing

Hint 10

•Progesterone stimulates hypothalamus to increase respirations. This causes mild resp. alkalosis, thereby improving the removal of CO2 from the fetus.

Front 11

Nasal congestion, swollen gums (rhinitis of pregnancy)
p. 543

Back 11

•Hypertrophy of mucous membranes
•Increased blood flood

Hint 11

•Estrogen

Front 12

Hoarseness and deepening of the voice

p. 543

Back 12

•Laryngeal changes during pregnancy are hormonally induced and include erythema and edema of the vocal cords accompanied by vascular dilation and small submucosal hemorrhages

Hint 12

•Estrogen

Front 13

Urinary frequency and nocturia

p. 380 and 384

Back 13

•Pressure on bladder from growing uterus.
•Increased glomerular filtration rate when the woman lies down.
•Bladder fills sooner.

Hint 13

•Promote retention: aldosterone, estrogen, deoxycorticosterone
•Promote excretion: Progesterone, prostaglandins

Front 14

Leg cramps

p. 632

Back 14

• Enlarging uterus puts pressure on pelvic nerves
- OR -
•May be related to calcium/phosphorus ratio changes that is related to neuromuscular irritability

Hint 14

•Promote retention: aldosterone, estrogen, deoxycorticosterone
•Promote excretion: Progesterone, prostaglandins

Front 15

Carpel tunnel syndrome
p. 555

Back 15

•Increased edema of pregnancy puts pressure on medial nerve at wrist

Hint 15

•Promote retention: aldosterone, estrogen, deoxycorticosterone
•Promote excretion: Progesterone, prostaglandins

Front 16

Backache
Hip and knee pain

p. 549-550

Back 16

•Growing uterus changes center of gravity causing low back pain.
•Enlarging breasts may cause thoracic backache.
•Ligamentous laxity
•Weight gain

Hint 16

•Relaxin softens elastic ligaments

Front 17

Sciatica (pressure on sciatic nerve)

Back 17

• Same as backache.
•sciatic nerve is the largest nerve in the body. Emerges from the spinal cord at L5 S1 and extends down the leg.

Front 18

Heartburn
p. 426

Back 18

•Relaxation of the lower esophageal sphincter

Hint 18

•Progesterone

Front 19

Fainting (Hint: there are two different physiological mechanisms that may cause fainting)

Back 19

• Supine hypotension
•Lower blood sugar Pregnant women have lower fasting blood sugars and higher post-prandial blood sugar

Front 20

Constipation
p. 426

Back 20

•Slowed peristalsis- More transit time means more loss of water from the stool and increased constipation.

Hint 20

•Progesterone